Instrumentalists express themselves through their artistic talent and virtuosity during long hours of playing music. Consequently, the manner in which they use their body during a performance has a direct impact on the quality of the performance. Controlled movements are essential when playing musical instruments, which consequently lead to nonoptimal asymmetric postures (Blanco-Piñeiro et al., 2015). The repeated use of certain joints and muscles and asymmetric utilization of the body with biased use of the hands, arms, and shoulders can cause musculoskeletal disorders and postural imbalance among many instrumentalists. Instrumentalists practice and play music with repetitive motions and postures; consequently, approximately 70%–80% of instrumentalists experience playing-related pain or musculoskeletal disorders (PRMDs) (Ackermann et al., 2014; Kenny and Ackermann, 2015; Lamontagne and Bélanger, 2015). In terms of psychological health, instrumentalists are more prone to anxiety, stress, and depression. Moreover, various studies have reported that 16%–55% of instrumentalists and undergraduates have music performance anxiety (MPA) (Gómez-López and Sánchez-Cabrero, 2023; Lamontagne and Bélanger, 2015). MPA has a negative effect on psychological health through the increase in levels of anxiety and depression. Therefore, overcoming MPA among instrumentalists is critical, not only for music-related factors that enhance the quality of the performance but also for the physical and psychological health benefits.

When experiencing PRMDs or psychological problems, many instrumentalists tend to reduce their practice time or evade performance engagements (Stanhope et al., 2014). Studies on PRMDs have so far focused mainly on the statistical analysis of pain-related characteristics of playing instruments and psychological pain in instrumentalists, while very few studies have explored the risk of occupational injury (Nair et al., 2023). The errors in the treatment of joint injury in instrumentalists may result from the use of a conventional treatment method that does not take into account the unique characteristics of instrumentalists with overuse syndrome (Rickert et al., 2012; Wilke et al., 2011). The conventional method of exercise-based treatment can alleviate pain, enhance muscle endurance and strength, and reduce stress, but it is inadequate to prevent PRMDs (Rethorst et al., 2009; Wajswelner et al., 2012). In light of this, a well-designed stretching or exercise program may serve as a nonpharmacological therapy for instrumentalists to resolve such problems (Kava et al., 2010).

Rhythmics in music-based exercise programs are likely to be a favorable strategy that reflects the concept of “somatics” and inner perceptions of physical balance and psychological stability. Somatics is concerned with first-person perspective motion, so it refers to all physical techniques that create changes inside the body. It has recently been introduced as movement therapy in several studies as part of the treatment of the body and mind (Phuphanich et al., 2020). The exercise program based on the concept of somatics in this study is thus presumed to be a good program that can incorporate psychological stability and physical balance perceived from inside the body of the participants. In rhythmics, sound and music are created through movements, and movements are created through music. The program used in this study was based on rhythmics to enable participants to express their inner selves through movements. The program was designed to arouse a natural sense of rhythm among participants, with the rhythm of music as the medium rather than artificial rhythm. A recent study by Ryu et al. (2023) reported low exercise intensity in their rhythmics program with the maximal heart rate at 62.85% and the rating of perceived exertion at 12.22. Such low-intensity exercise programs are thought to be a good method to simultaneously promote psychological stability and the positive effects of rhythm-based exercise. It is important to verify the effects of understanding movement based on music, which is a familiar medium for instrumentalists, in terms of postural correction and emotional alterations that interact in daily life. This study aimed to investigate the effects of a novel music-based exercise program on the postural balance, quality of life, stress response, and self-esteem of instrumentalists.

This study aimed to determine the effect of an 8-week music-based exercise program on the postural balance and emotional factors among instrumentalists. The measured changes in postural balance did not reveal a significant positive effect on musculoskeletal imbalance and misalignment, showing deviation. Kava et al. (2010) administered a 6-week Pilates program to undergraduate instrumentalists, which led to a significant improvement in upper limb muscle strength but had no effect on postural alignment. Likewise, Poncela-Skupien et al. (2020) provided a 4-week Pilates interventional program to young string instrumentalists, and similarly, the participants had a positive pain reduction, but the program had no effect on postural alignment. The rhythm in the music-based exercise program in this study allowed for natural movements based on the sense of rhythm in response to external stimuli. Through creative motions that release energy that converges time and space focusing on the participants’ inner feelings, certain movements are limited or permitted that revitalize physical functions not usually harnessed. The activity perceives one’s own body and reflects potential energy, promoting motion and linking music as a medium with movements. People usually unconsciously use one part of the body repetitively, and in the study, the participants likewise had a habitual posture or pattern of movements. As an intervention, the participants performed freestyle exercises without restriction to their posture or pattern of movements. Thus, the participants did not actively perform structured motions to improve postural imbalance, such as stabilization of a specific area of imbalance, relaxation, stretching of activated muscles, strengthening of weakened muscles, or balancing of asymmetric muscle activities. Consequently, no notable improvement was found in the indicators of postural balance.

In this study, significant improvements were detected across all variables, QoL, stress response, and self-esteem. Regular physical activities are known to enhance physical and psychological health, as well as QoL. A person’s QoL is not a simple indicator of survival but a state of subjective psychological well-being, determined by physical, social, and mental health. Thus, maintaining a balance among each domain is critical, and in this study, all assessed subcategories, from physical and psychological health to social relationships and environment, displayed significant changes. In a study on 106 older adults the overall QoL on the World Health Organization Quality of Life scale increased after prescription of a personalized exercise program (Kekäläinen et al., 2018). In a meta-analysis of physical activities and QoL among 19,731 undergraduates, a positive correlation was found between physical activity and overall QoL (Abrantes et al., 2022). In this study, the four subcategories of QoL revealed that the changes induced by satisfaction with the program led to a positive attitude towards life.

The results of this study demonstrated a decrease in stress response and significant increase in self-esteem on the SRI scale and RSES, respectively. Exercises such as musical aerobics exert an influence on creativity and self-identity (Herman-Tofler et al., 1998), with a close association to depression, anxiety, stress, mood, and self-respect (Scully et al., 1998). In a study by Ozdemir and Saritas (2019) self-esteem increased after 4 months or more of yoga training, which suggested an effect of physical changes through movements on emotional stability, as the peace of mind after yoga enabled one to reflect on inner strength and regain emotional stability. Sonstroem and Morgan (1989) claimed that a successful exercise could have a positive impact on self-esteem. The findings of these studies imply that physical movements and regular exercise can contribute to reducing stress factors and enhancing one’s self-esteem. A recent study reported that rhythm is a repeating pattern of energy that can assist with muscle contraction and relaxation, while a kinesthesia may have a role in the realization of the inner self (Wilson and Henley, 2022). The rhythmics program applied in this study was conjectured to have a positive effect on psychological relaxation, as participants responded to rhythm and sounds through movement, whereby repressed thoughts could be dissipated through movement. Rhythm is present even in the quiet moments between adjacent sounds, and being aware of that rhythm enables humans to regain the balance of sub-consciousness.

In conclusion, all emotional factors had synergistic effect on each other generating improvement. The results of this study showed that rhythmic elements in a music-based exercise program had positive effects on emotional factors, but not on postural balance. Thus, exercise programs for instrumentalists should be designed to incorporate specialized exercises for the improvement of postural balance factors with an intensity that reflects balance-related factors to ensure synergistic effects with music-related factors.